Cardiac sarcoidosis should be suspected in young to middle-aged adults with unexplained complete heart block, ventricular tachycardia, or cardiomyopathy. Which imaging modality is now considered the reference standard for detecting cardiac sarcoidosis granulomas?
- A Transthoracic echocardiography
- B Cardiac MRI with late gadolinium enhancement (LGE) and T2 mapping ✓
- C Coronary CT angiography
- D Technetium-99m pyrophosphate scan
Correct answer: B. Cardiac MRI with late gadolinium enhancement (LGE) and T2 mapping
Explanation
Cardiac MRI with late gadolinium enhancement (LGE) and T2 mapping is the current reference standard for diagnosing cardiac sarcoidosis. Active granulomas show T2 hyperintensity (oedema), while fibrotic scar from healed granulomas shows LGE — characteristically patchy, predominantly basal/septal, epicardial/mid-myocardial distribution (not subendocardial as in ischaemia). PET-CT (18F-FDG) is complementary for active inflammation. The HRS 2014 criteria incorporate LGE-CMR findings for diagnosis. Tc-99m pyrophosphate is used for ATTR amyloidosis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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